Tuesday, September 06, 2005

In Part 1, we discussed a recent study that looked at the (hypothesized) relationship between genetic diseases and intelligence. The subjects of the study happened to be a specific population of Jews, who on the one hand display above-average intelligence, but on the other are more prone to a deadly disease. Now, what does this have to do with insurance?

We’ve addressed the general topic of genetic testing in insurance underwriting before. It’s been many years since insurance applications asked one’s race, and I’m reasonably certain that (with the exception of certain fraternal carriers), the question of religion wasn’t even brought up [ed – if any readers know otherwise, please let me know].

The question arises, however, as to whether or not carriers should be testing for such potential time bombs. In other words, is it necessarily a good thing that genetics-based underwriting is prohibited? If insurance is truly about risk management, then doesn’t it make sense that a carrier should have an accurate picture of that risk?

In Great Britain, the government and the insurance industry have been wrestling with this dichotomy for some time. A voluntary moratorium was recently extended; insurers in GB have agreed to abjure from using “predictive genetic test results” until 2011. And here in “the colonies,” a recent HCFO article acknowledges that “(g)enetic testing will undoubtedly have broad effects on health care financing in the insurance context and elsewhere.”

The challenge is going to be one of balance: insurers need accurate and complete information about a given risk, while prospective insureds shouldn’t be penalized for something over which they have no control. As noted in Part 1, certain populations are at increased risk for certain conditions: blacks and sickle cell, Ashkenazim and Tay-Sachs, women and breast cancer, etc. If insurers can’t ask about race and religion, then how do they accurately price a given risk? On the other hand, when we read about how vulnerable information databases may be, how do we trust such information to remain private?

I sympathize with the carriers’ need to know as much as possible about a prospect’s health history, and can even see how genetic information can be useful in correctly pricing a risk. But I think that this is far outweighed by an individual’s right not to be adversely affected by such information over which, after all, one has no control.

There is one area of insurance where such information can, and should, be exploited: according to the HCFO study, “genetic testing is most often used to confirm diagnoses or to predict who is most at risk for a particular disease or condition. Advance knowledge of risk factors could point to preventive services or the need for early detection, and could allow providers to more cost-effectively target services.” The goal should be to balance the “good” (claims management, preventive care) with the “bad” (risk to privacy, unfair discrimination).

In Part 1, we discussed a recent study that looked at the (hypothesized) relationship between genetic diseases and intelligence. The subjects of the study happened to be a specific population of Jews, who on the one hand display above-average intelligence, but on the other are more prone to a deadly disease. Now, what does this have to do with insurance?

We’ve addressed the general topic of genetic testing in insurance underwriting before. It’s been many years since insurance applications asked one’s race, and I’m reasonably certain that (with the exception of certain fraternal carriers), the question of religion wasn’t even brought up [ed – if any readers know otherwise, please let me know].

The question arises, however, as to whether or not carriers should be testing for such potential time bombs. In other words, is it necessarily a good thing that genetics-based underwriting is prohibited? If insurance is truly about risk management, then doesn’t it make sense that a carrier should have an accurate picture of that risk?

In Great Britain, the government and the insurance industry have been wrestling with this dichotomy for some time. A voluntary moratorium was recently extended; insurers in GB have agreed to abjure from using “predictive genetic test results” until 2011. And here in “the colonies,” a recent HCFO article acknowledges that “(g)enetic testing will undoubtedly have broad effects on health care financing in the insurance context and elsewhere.”

The challenge is going to be one of balance: insurers need accurate and complete information about a given risk, while prospective insureds shouldn’t be penalized for something over which they have no control. As noted in Part 1, certain populations are at increased risk for certain conditions: blacks and sickle cell, Ashkenazim and Tay-Sachs, women and breast cancer, etc. If insurers can’t ask about race and religion, then how do they accurately price a given risk? On the other hand, when we read about how vulnerable information databases may be, how do we trust such information to remain private?

I sympathize with the carriers’ need to know as much as possible about a prospect’s health history, and can even see how genetic information can be useful in correctly pricing a risk. But I think that this is far outweighed by an individual’s right not to be adversely affected by such information over which, after all, one has no control.

There is one area of insurance where such information can, and should, be exploited: according to the HCFO study, “genetic testing is most often used to confirm diagnoses or to predict who is most at risk for a particular disease or condition. Advance knowledge of risk factors could point to preventive services or the need for early detection, and could allow providers to more cost-effectively target services.” The goal should be to balance the “good” (claims management, preventive care) with the “bad” (risk to privacy, unfair discrimination).